Provider Demographics
NPI:1396358479
Name:MEDDYG GROUP LLC
Entity Type:Organization
Organization Name:MEDDYG GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESSED
Authorized Official - Middle Name:O
Authorized Official - Last Name:ACEVEDO CORREA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:939-299-0113
Mailing Address - Street 1:PO BOX 1019
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-1019
Mailing Address - Country:US
Mailing Address - Phone:939-299-0113
Mailing Address - Fax:
Practice Address - Street 1:7 CALLE RAMON EMETERIO BETNACES
Practice Address - Street 2:ESQUINA DE DIEGO
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680
Practice Address - Country:US
Practice Address - Phone:939-299-0113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty